Localized extradural lymphoma: survival, relapse pattern and functional outcome

Rathmell, A.J.; Gospodarowicz, Mary K.; Sutcliffe, Simon; Clark, Roy M.

doi:10.1016/0167-8140(92)90348-x

Cited by 39 publications

(37 citation statements)

References 19 publications

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“…But it has been suggested that primary lymphoma may develop de novo from epidural lymphoid rest [4]. The proportion between patients with SEI and neurological signs at presentation or complication event is unsettled (&85%), and patients with undiagnosed NHL represent 11 % of spinal cord compressions from metastatic tumor [3]. In our patients, histopathology features were unusual and consisted of lymphoplasmocytic NHL.…”

Section: Acknowledgmentsmentioning

confidence: 93%

“…But in all series, the numbers are too small to study specific survival among prognostic factors [5]. Concerning localized epidural NHL, Rathmell et al [3] showed that radiotherapy combined with chemotherapy gives better results on distant relapse free rate (100%) and survival rate (86%) compared with radiotherapy alone (23% and 36%, respectively). This report concerns intermediate or high-grade NHL for 85% of the patients.…”

Section: Acknowledgmentsmentioning

confidence: 97%

“…Histopathological findings in SEI have described mostly intermediate and high-grade NHL. In the last 10 years' literature, we found only 5 cases of group A low-grade NHL presenting with SEI [2,3]. Between 1982-1994, 4 patients with lymphoplasmocytic NHL and SEI were treated in our institution (Table I).…”

mentioning

confidence: 95%

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Lymphoplasmocytic malignant lymphoma presenting with spinal epidural involvement: Four reports of this uncommon lesion

et al. 1995

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Section: Acknowledgmentsmentioning

confidence: 93%

Section: Acknowledgmentsmentioning

confidence: 97%

See 1 more Smart Citation

Lymphoplasmocytic malignant lymphoma presenting with spinal epidural involvement: Four reports of this uncommon lesion

et al. 1995

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“…5 cm 41 have all been observed in individual studies to be potential risk factors for CNS involvement, but the findings have not been consistently replicated. Epidural involvement was associated with increased CNS risk in prerituximab case series, [42][43][44][45] however, contemporary data are lacking. Sinus involvement was associated with marginally increased CNS risk (6% in the prerituximab era) which was reduced to 1.6% when rituximab was incorporated into primary therapy.…”

Section: 33mentioning

confidence: 99%

How I treat patients with aggressive lymphoma at high risk of CNS relapse

Chin

Cheah

2017

Blood

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Central nervous system (CNS) relapses are an uncommon yet devastating complication of non-Hodgkin lymphomas. The identification of patients at high risk of secondary CNS relapse is therefore paramount. Retrospective data indicate prophylactic CNS-directed therapies may reduce the risk of CNS involvement; however, no consensus exists about dose, timing, or route of therapy. In addition, prophylaxis is not without risk of treatment-related complications and morbidity. Here, we present a series of case vignettes highlighting our approach to common dilemmas encountered in routine clinical practice. We review the method of assessing CNS relapse risk, factors that increase the likelihood of relapse including histologic subtype, MYC rearrangement, protein expression, and extranodal involvement, and review our clinical practice based on available evidence in administering CNS-directed prophylaxis. (Blood. 2017;130(7):867-874) IntroductionNon-Hodgkin lymphomas are biologically and clinically diverse hematological malignancies. Treatment is influenced by patient fitness, disease biology, and tumor burden. Identifying patients at high risk of central nervous system (CNS) relapse is important as the outcome of secondary CNS lymphoma is poor. [1][2][3][4] Risk of CNS progression is influenced by histologic subtype and subtype-specific clinicopathologic features (eg, site of involvement, protein expression, or gene rearrangements). Patients with highly aggressive lymphomas (eg, lymphoblastic, Burkitt lymphoma) are at high risk and frontline protocols include CNS-directed prophylaxis. In contrast, indolent lymphomas rarely involve the CNS and CNS prophylaxis is not required. Between these extremes fall diffuse large B-cell lymphoma (DLBCL), high-grade B-cell lymphoma (HGBL) with MYC and BCL2 or BCL6 rearrangements, so-called "double-hit" lymphomas (HGBL-DH), and (nodal) peripheral T-cell lymphomas (PTCLs). The addition of rituximab has slightly reduced CNS relapse in DLBCL, probably through superior systemic control as there is negligible CNS penetration of the drug across the intact blood-brain barrier. 1,5 However, ;4% of unselected patients with DLBCL treated with prednisone, vincristine, cyclophosphamide, doxorubicin, and rituximab (R-CHOP) experience CNS relapse, 6,7 and considerable efforts have been made to identify those at greatest risk. In this review, we will summarize our approach to this problem with case vignettes drawn from our practice. How I identify patients at increased risk for CNS relapseMany investigators have examined risk factors for CNS relapse, but studies have yielded inconsistent results, due to heterogeneity in patient populations, treatment, and/or limited sample size. [8][9][10][11][12][13][14][15][16] To address some of these limitations, Schmitz et al developed a 6-point score from 2164 patients treated on prospective German studies and validated in 1597 patients with DLBCL treated with R-CHOP in the British Columbia Cancer Agency (BCCA) Lymphoid Malignancies Database. 6 The components of the s...

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“…Des résultats du RCN ont été confirmés par d'autres séries, avec un excellent contrôle local du lymphome, mais avec un taux assez significatif (40 à 50 %) de rechute à distance, dont environ 10 % au niveau du système nerveux central. Dans ces études, une majorité de patients a été traitée par radiothérapie et chimiothérapie combinée, sans thérapie ciblée de type anticorps anti-CD20 [10]. Il est donc plausible que le pronostic des LNH épiduraux spinaux, déjà relativement favorable, soit amélioré par les nouvelles approches thérapeutiques des lymphomes.…”

Section: Lymphomes Non Hodgkiniens (Lnh) éPidural Spinalunclassified

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Peters

Mirimanoff

2011

Thérapeutique Du Cancer

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Localized extradural lymphoma: survival, relapse pattern and functional outcome

Cited by 39 publications

References 19 publications

Lymphoplasmocytic malignant lymphoma presenting with spinal epidural involvement: Four reports of this uncommon lesion

Lymphoplasmocytic malignant lymphoma presenting with spinal epidural involvement: Four reports of this uncommon lesion

How I treat patients with aggressive lymphoma at high risk of CNS relapse

Les tumeurs rares

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